Pressure Diggers Boom Trucks

Credit Application

Please complete the following form to apply for credit.

Business Information
 
Business Name:
DBA:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Federal ID #:
Years In Business:
Years Current Owner:  
# of Employees:
Type: Corporation Public Corporation LLC Partnership
Limited Partnership Proprietorship Municipal
 
Principal #1
 
Principal Name:
Title:
Address:
City:
State:
Zip:
Phone:
Rent or Own:
How Long There:
Drivers License #:
Social Security #:
% Ownership:
 
Principal #2
 
Principal Name:
Title:
Address:
City:
State:
Zip:
Phone:
Rent or Own:
How Long There:
Drivers License #:
Social Security #:
% Ownership:
 
Principal #3
 
Principal Name:
Title:
Address:
City:
State:
Zip:
Phone:
Rent or Own:
How Long There:
Drivers License #:
Social Security #:
% Ownership:
 
Bank Reference #1
 
Bank Name:
Years w/ Bank:
Account #:
Contact:
Phone:
Fax:
 
Bank Reference #2
 
Bank Name:
Years w/ Bank:
Account #:
Contact:
Phone:
Fax:
 
Trade Reference #1
 
Trade Name:
Account #:
Contact:
Phone:
Fax:
 
Trade Reference #2
 
Trade Name:
Account #:
Contact:
Phone:
Fax:
 
Trade Reference #3
 
Trade Name:
Account #:
Contact:
Phone:
Fax:
 
Lease or Loan Reference #1
 
Lease Name:
Account #:
Contact:
Phone:
Fax:
 
Lease or Loan Reference #2
 
Lease Name:
Account #:
Contact:
Phone:
Fax:
 
Agreement and Signature
 
Applicant Name:
Title:
  BY CHECKING THIS BOX AND ENTERING MY NAME AND TITLE ABOVE, I DO HEREBY CERTIFIY THAT THE ABOVE INFORMATION, GIVEN FOR CREDIT PURPOSES, IS TRUE AND AUTHORIZES THE FIRM OR PERSON TO WHOM THIS APPLICATION IS MADE AND ANY CREDIT BUREAU OR OTHER INVESTIGATIVE AGENCY TO INVESTIGATE THE PRINCIPAL(S)AND BUSINESS REFERENCES, STATEMENTS OR OTHER DATA LISTED OR ACCOMPANYING THIS APPLICATION. THE UNDERSIGNED AUTHORIZES ALL PARTIES CONTACTED TO RELEASE CREDIT AND FINANCIAL INFORMATION REQUESTED AS A PART OF SAID INVESTIGATION.
 

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